| NPI | 1760939771 |
|---|---|
| Former Name | JENNIFER A RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71006520A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71006520A) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2022-10-21 |